FORM 1023-EZ for CLEARWATER BOOSTER CLUB

Field Data
EIN 48-1180071
Case Number EO-2017298-000412
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CLEARWATER BOOSTER CLUB
Organization’s Mailing Address PO BOX 28
City CLEARWATER
State KS
ZIP 67026
Accounting period End 12
Primary contact name CASEY CARLSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

STEVE LILL
PRESIDENT
10530 BLUEWATER CT
CLEARWATER KS 67026

Officer/Director/Trustee Two

AARON TJADEN
VICE PRESIDENT
201 S GRAIN
CLEARWATER KS 67026

Officer/Director/Trustee Three

JENNIFER MARTIN
TREASURER
16220 W K42 HWY
CLEARWATER KS 67026

Officer/Director/Trustee Four

CASEY CARLSON
OFFICER
902 CLEAR CREEK
CLEARWATER KS 67026

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/26/1996
Organization Incorporation State KS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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